Ornament

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Ornament

CPT Notes


Easy Steps to a Safer Pregnancy - View e-book or Download PDF - FREE!
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.



 

Prolonged services


Critical Care and Prolonged Care Codes Address Intensity of Family Physician Services from the American College of Osteopathic Family Physicians

From: http:

Prolonged services involve direct face-to-face contact between the physician and the patient that is beyond the usual service in either the inpatient or outpatient setting. The codes should be used to report the total duration of face-to-face time on a given date, even if the time spent by the physician on that date is not continuous. 

National Coverage Provision

Subject Name: Prolonged Evaluation and Management Services and Standby Services

Subject Number: PHYS-031

Description:
Prolonged services involve direct face-to-face contact between the physician and the patient that is beyond the usual service in either the inpatient or outpatient setting. The codes should be used to report the total duration of face-to-face time on a given date, even if the time spent by the physician on that date is not continuous.

Procedure Codes CPT or HCPCS:
99354 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour (List separately in addition to code for service of other outpatient Evaluation and management Service)
99355 each additional 30 minutes (List separately in addition to code for prolonged physician services)
99356 Prolonged physician service in the inpatient setting, requiring direct (face-to-face) patient contact beyond the usual service (eg, maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient); first hour (List separately inaddition to code for inpatient Evaluation and management Service)
99357 each additional 30 minutes (List separately in addition to code for prolonged physician services)
99358 Prolonged evaluation and management service before and/or after direct (face to face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour (List separately in addition to code(s) for other physician service(s) and/or inpatient or outpatient Evaluation and Management service)
99359 each additional 30 minutes hour (List separately in addition to code for prolonged physician service)
99360 Physician standby service, requiring prolonged physician attendance, each 30 minutes (eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG)

Indications and Limitations of Coverage:

  1. Prolonged codes can be billed only if the total duration of all physician direct face to face service (including the visit) equals or exceeds the threshold time for the evaluation and management service the physician provided (typical time plus 30 minutes). If the total duration of direct face to face time does not equal or exceed the threshold time for the level of evaluation and management service the physician provided, the physician may not bill for prolonged services.
    1. In the case of prolonged services, time spent by office staff with the patient, or time the patient remains unaccompanied in the office, cannot be billed.
    2. In the case of prolonged hospital services, time spent waiting for test results, for changes in the patientís condition, for end of a therapy, or for use of facilities, cannot be billed as prolonged services.

    3.  

       
       
       
       
       

  2. Prolonged services without face-to-face service (codes 99358-99359) are not covered by Medicare. These services are included in the payment for direct face-to-face services provided by the physician.
  3. Physician standby services (code 99360) are not covered by Medicare. Standby services are considered a service to the hospital and cannot be billed to the beneficiary. This is a Part A benefit.
  4. Threshold times for codes 99354 and 99355. When the total direct face-to-face time equals or exceeds the threshold time for 99354, but is less than the threshold time for 99355, the physician should bill the visit and code 99354.

  5.  

     
     
     
     
     

    When the total direct face-to-face time equals or exceeds the threshold time for 99355 by no more than 29 minutes, the physician should bill the visit code 99354 and one unit of 99355. One additional unit of code 99355 is billed for each additional increment of 30 minutes extended duration. Refer to Appendix B to determine if the prolonged service codes 99354 and/or 99355 can be billed with the office/outpatient visit and consultation codes.

  6. Threshold times for codes 99356 and 99357. When the total direct face-to-face time equals or exceeds the threshold time for code 99356, but is less than the threshold time for code 99357, the physician should bill the visit and code 99356.

  7.  

     
     
     
     
     

    When the total direct face-to-face time equals or exceeds the threshold time for code 99356 by no more than 29 minutes, the physician bills the visit code 99356 and one unit of code 99357. One additional unit of code 99357 is billed for each additional increment of 30 minutes extended duration. Refer to Appendix C to determine if the prolonged service codes 99356 and/or 99357 can be billed with the office/outpatient visit and consultation codes.

  8. Documentation in the patientís progress notes must support billing for prolonged services. Documentation does not need to be submitted with the claim but must be available upon request. The patientís Medical record must document the duration and content of the E&M code billed and that the physician have personally furnished at least 30 minutes of direct service after the typical time of the evaluation and management service had been exceeded by at least 30 minutes.
Covered ICD-9 Codes:
N/A

Coding Guidelines:

  1. List the appropriate prolonged care CPT code(s) with the appropriate companion E&M service provided; refer to appendix A.
  2. Calculate the appropriate time involved and report according to information in Appendix B or C.
    1. 99355 must be billed with 99354. 99357 must be billed with 99356.
    2. For codes 99354 and 99356, only one unit of service per day is allowed
    3. Additional time is reported with codes 99355 or 99357, with the units of service that reflects the total time.

    4.  

       
       
       
       
       

    Appendix A- Appropriate Companion Codes
    Prolonged Code(s) E&M Codes
    99354 (office or outpatient) 99201-99205
    99355 (office or outpatient) 99212-99215
    99241-99245
    99341-99345*
    99347-99350*
    Prolonged Code(s) E&M Codes
    99356 (Inpatient) 99221-99223
    99357(Inpatient 99231-99233
    99251-99255
    99261-99263
    99301-99303
    99311-99313

    Appendix B-Threshold times for codes 99354 and 99355
    Code
    Typical Time 

    for code

    Threshold time to bill code 99354
    Threshold time to bill codes 99354 & 99355
    99201

    99202

    99203

    99204

    99205

    99212

    99213

    99214

    99215

    99241

    99242

    99243

    99244

    99245

    99341*

    99342*

    99343*

    99344*

    99345*

    99347*

    99348*

    99349*

    99350*

    10

    20

    30

    45

    60

    10

    15

    25

    40

    15

    30

    40

    60

    80

    20*

    30*

    45*

    60*

    75*

    15*

    25*

    40*

    60*

    40

    50

    60

    75

    90

    40

    45

    55

    70

    45

    60

    70

    90

    110

    50*

    60*

    75*

    90*

    105*

    45*

    55*

    70*

    90*

    85*

    95*

    105*

    120*

    135*

    85*

    90*

    100*

    115*

    90*

    105*

    115*

    135*

    155*

    95*

    105*

    120*

    135*

    150*

    90*

    100*

    115*

    135*

    Add 30 minutes to the threshold time for billing codes 99354 and 99355 to get the threshold time for billing code 99354 and 2 units of code 99355.

    Appendix C-Threshold times for codes 99356 and 99357
    Code
    Threshold time for code
    Threshold time to bill code 99356
    Threshold time to bill codes 99356 & 99357
    99221

    99222

    99223

    99231

    99232

    99233

    99251

    99252

    99253

    99254

    99255

    99261

    99262

    99263

    99301

    99302

    99303

    99311

    99312

    99313

    30

    50

    70

    15

    25

    35

    20

    40

    55

    80

    110

    10

    20

    30

    30

    40

    50

    15

    25

    35

    60

    80

    100

    45

    55

    65

    50

    70

    85

    110

    140

    40

    50

    60

    60

    70

    80

    45

    55

    65

    105

    125

    145

    90

    100

    110

    95

    115

    130

    155

    185

    85

    95

    105

    105

    115

    125

    90

    100

    110

    Add 30 minutes to the threshold time for billing codes 99356 and 99357 to get the threshold time for billing code 99356 and 2 units of 99357.
     
     



This Web page is referenced from other pages containing related information about Money and Paperwork

 




SEARCH gentlebirth.org

Main Index Page of the Midwife Archives

Main page of gentlebirth.org         Mirror site

Please e-mail feedback about errors of fact, spelling, grammar or semantics. Thank you.

Permission to link to this page is hereby granted.
About the Midwife Archives / Midwife Archives Disclaimer